Myolysis

In myolysis,
surgical instruments are inserted through a tiny, laparoscopic incision in
the abdomen and a high frequency electrical current is administered to the
fibroid. The electrical current causes the blood vessels to vaso-constrict
(become very small or close down) and this basically cuts off the blood flow
to the fibroids. The fibroids remain in place and are not surgically removed.
Without a blood supply, the fibroids eventually die and shrink just as they
do with uterine artery embolization.

Cryomyolysis
is a similar procedure that "freezes to death" the fibroids. Liquid nitrogen
at minus 180 degrees Celsius is applied through a cryoprobe while the doctor
monitors the freezing process using ultrasound.

Both procedures
take about one hour and the patient is observed in the recovery room for approximately
another three hours and then discharged to go home. Total recovery from this
procedure takes about one week.

There are
many potential side effects to this drug which was originally developed
and FDA-approved for the treatment of advanced prostate cancer in men.
These days, however, Lupron is widely used by gynecologists to treat
women for a variety of routine gynecological problems.

According
to a special report series published by the Boston Herald in August
1999 (email me if you'd like to read this report), some specialists
are now saying that the long-term effects of Lupron can be dangerous
and harmful, and that not enough studies have been done to adequately
demonstrate that it is safe and effective.

As with
any other potential treatment option available for your uterine fibroids,
it is important to weigh the risks and benefits of potential outcome
for each option against your own specific condition, belief system,
and overall need for resolution to your situation. Lupron has helped
many women. It has also hurt many women. Only you can weigh what
potential benefit you might receive/not receive from its use and what
risks you are willing to take/not take in the pursuit of treating your
uterine fibroids.

Oh, did I mention
that the prescriptive use of GnRH agonists (like Lupron) is generally required
for 3-6 months pre-procedure? In order to maximize the potential shrinkage
that results from this procedure, the patient is requested to undergo GnRH
therapy as a precursor. Hopefully, the fibroids shrink somewhere in the 50%
range and this makes the procedure easier to perform as well as gives the
patient a better "starting point" to experience shrinkage of their
fibroids from with the myolysis/cryomyolysis procedure. The use of Lupron,
however, is controversial.

Neither myolysis
nor cryomyolysis can be performed on very large fibroids (anything over 10
cm pre-administration of GnRH agonists is considered "very large")
nor can they be performed if there are more than 4 fibroids each with a volume
of up to 5 cm. Also, anything less than 3 cm in size is, well, too small.

In other words:

Fibroids that
are too large complicate the procedure and make the shrinkage less than
ideal in the long run -- bulk-related symptoms may not be resolved when
the size of the fibroid at the time of the procedure is still very large;
too many fibroids may make the amount of time it takes to perform the procedure
impossible; and, too small of fibroids (less than 3 cm) are simply too small
to perform this procedure on. (Kind of sounds like I'm telling you the
story of The Three Bears, doesn't it? Fibroids can be classified as Papa
Bear, Mama Bear, or Baby Bear. Only in this case the fibroids that are "just
right" can only be assessed by Goldilocks, err, I mean, your gynecologist.
The "ideal size" is probably Mama Bear -- but only if there are
not too many of them.)

History of Myolysis

Myolysis is a
procedure that has been around since the late 1980s in Europe and was first
used as an alternative to myomectomy for women interested in preserving fertility.
It fell out of favor in Europe, however, because follow-up showed that it
was not a good alternative afterall. Pregnancy rates were low and fibrous
pelvic adhesions were common.

In the United
States, not too many doctors perform myolysis. It's the "baby" of
Dr. Herbert Goldfarb as he introduced it to the U.S. gynecological community
sometime around 1994. However, it has not been widely accepted by gynecologists
and, according to Dr. Goldfarb's website, only around 800 patients have undergone
this procedure.

There really
isn't a whole lot of information on the internet about this procedure because
only doctors who are thoroughly experienced laparoscopical operators should
attempt this procedure. Both skill AND special equipment are required to perform
this procedure and this may well account for the low number of patients that
have actually undergone this procedure. To find out who has actually been
trained in your area so that you can learn more, send email directly to Dr.
Goldfarb.

Fertility

There appears
to be conflicting information -- on the internet and among some gynecologists
-- on the issue of fertility after myolysis. Some doctors say that myolysis
is a good alternative to hysterectomy -- especially for women who want to
retain their ability to have children.

Because of the
potential risk of the uterus tearing during labor, it's important that women
not attempt to get pregnant after myolysis or cryomyolysis, according to Dr.
Parker.

In a recent interview
with Dr. Herbert Goldfarb, he most emphatically agreed with Dr. Parker's assessment.
In fact, he indicated that he has always been diligent about not offering
this procedure to women who intend to become pregnant in the future. The risk
of uterine rupture is simply too great. Nonetheless, some gynecologists offering
this procedure have not shown due diligence in this regard and several women
have experienced uterine rupture with pregnancy as a result.